Candidate: Dr. Robert Michael Sutton, Assistant Professor of Anesthesia, Critical Care, and Pediatrics at the University of Pennsylvania (UPenn), and Pediatric Critical Care Attending Physician at the Children's Hospital of Philadelphia (CHOP), is applying for a Mentored Patient-Oriented Research Career Development Award (K23). This candidate has an established record of academic and research excellence, and the investigation proposed in this application is a natural progression of his growing expertise in assessing CPR quality. The candidate will conduct a prospective interventional trial evaluating the existing quality of in-hospital pediatric CPR and the effectiveness of defibrillators with automated audiovisual feedback to improve compliance with American Heart Association (AHA) pediatric CPR guidelines. Subsequently, through an analytic approach novel to pediatric resuscitation research, the candidate will obtain data to challenge the existing CPR guidelines, which have been developed by expert consensus using available animal and adult data. This investigation will place the candidate at the forefront of pediatric CPR quality research, prime his career for future independent investigations, and establish a research niche that is complementary to yet distinct from his accomplished mentors. Dr. Sutton aspires to become an independent resuscitation scientist working in a leading academic institution with greater than 75% time committed to patient-oriented resuscitation research. His long term goal is to lead a research team focused specifically on improving CPR process with the overall goal of improving survival and quality of life outcomes for children who suffer a cardiopulmonary arrest. The candidate's career activities during this award have been selected to ensure his transition to independent resuscitation scientist. Environment: The career development plan and the intended research investigation build upon an existing network of research and mentorship already in place at the candidate's institution. Experts in resuscitation research have developed a clinical learning laboratory to study cardiac arrest. The candidate has played an integral role in the development of these networks and will continue to collaborate and receive mentorship from this talented group. As a student in the Center for Clinical Epidemiology and Biostatistics at UPenn, the candidate will continue training in epidemiologic methods, but will also have extensive statistical resources committed to the completion of the research investigation. In short, the environment available to the candidate coupled with an established and internationally recognized team of mentors, all but guarantee the success of the proposed career development award. Research: Context: Cardiac arrests in children are a major public health problem. The quality of healthcare provider CPR during adult resuscitations typically does not comply with American Heart Association (AHA) clinical practice guidelines. CPR monitoring defibrillators with audiovisual feedback improve adult CPR quality and clinical outcomes. This same technology can now practically be used to assess and improve CPR guideline compliance in younger children. Objective: Characterize the current landscape of CPR quality during in-hospital pediatric cardiac arrest, determine the effect of audiovisual feedback to improve compliance with the existing consensus-based CPR guidelines, and begin to challenge the paradigm that these consensus-based guidelines achieve acceptable physiologic outcomes associated with survival. Study Design: The design of the protocol is a prospective before-after interventional study design. The existing quality of CPR performed during pediatric resuscitations will be recorded using CPR monitoring defibrillators during a 24 month Control (Before) Period. The Intervention (After) Period represents a 24 month period during which the effect of audiovisual feedback to improve compliance with our existing consensus-based CPR guidelines will be determined. In a final exploratory aim, compliance with existing guidelines will be associated to arterial blood pressures to determine if compliance with our existing consensus-based pediatric CPR guidelines achieves acceptable physiologic outcome. Summary: The proposed timely and innovative investigation will change the landscape of pediatric resuscitation science from an evidence-poor to an evidence-rich platform. The informative data obtained coupled with formal statistical training in methods novel to resuscitation research, will place the candidate at the forefront of pediatric CPR quality research. By establishing a research niche distinct from his mentors, the candidate's career will be primed for future independent research investigations designed to improve quality of life outcomes for children who suffer a cardiac arrest.